Are you making these common mistakes in Prior Authorization?

May 04,2016 / By Som Chaudhuri

Som Chaudhuri

Healthcare business is constantly evolving with time. In the present age, quality customer service is the buzzword among industries irrespective of their business vertical. Healthcare providers too are looking to provide quality care to the patients.

However, it is a known fact that streamlining operational activities, especially practice management, medical billing & accounts receivable, has to be the top priority. A transparent strategy for prior authorization services is a must for the providers to survive fierce competition.

The common pitfalls __________________________________________________________________________

Authorization services set the tone for your claims submission process. You have to set the right benchmark that will allow a smooth medical billing process to follow. Some of the frequent mistakes that are witnessed include

~ Lack of vision: The absence of the right roadmap with effective checks & balances for verification services can eventually be catastrophic for a provider. It will ultimately impact your growth & ROI with inconclusive claims submission process.

~ Absence of technical acumen: Understanding of the individual patient’s benefits-verification and updating the information on software today has to supported by relevant software support & handling. Providers may not have the skill set to follow the right practice for prior approval process.

~ Incorrect range in CPT code: Mentioning the right code in CPT especially in higher range guarantees payment from the Payer. It is a challenge for inexperienced professionals in-house to anticipate & provide the right range even before the service is rendered. Lack of the right code range will result in loss of reimbursement.

Destination outsourcing _______________________________________________________________________

Finding the right vendor in outsourcing will end your woes with:

~ Automation in process: Robust technology platforms help in streamlining the entire practice management process. It starts with the right verification of benefits to patient demographics that reduces time & increases ROI in near future.

~ Knowledge of payer requirements: Top outsourcing partners in healthcare work with a number of insurance companies helping them in their claims adjudication process. It gives them the expertise to handle verification processes keeping an alignment to an individual payer’s requirements contributing to a better denial management system.

We can conclude by saying that finding the right vendor who will handle your accounts in a disciplined manner will eventually lay down your roadmap for growth.

 

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